School Lunch Entree Components Before and After Implementation of the Healthy, Hunger-Free Kids Act of 2010: A Secondary Data Analysis

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Background The Healthy, Hunger-Free Kids Act (HHFKA) 2010 updated standards to increase the quality and quantity of healthy items offered to students. Since HHFKA implementation, studies have focused primarily on fruit and vegetable selection and consumption, nutrient quality of whole meals, and plate waste. Objective Complete existing descriptions of the HHFKA’s impact by examining changes in nutrient quality and entrée quantity without inclusion of the required vegetable and fruit servings. Design Descriptive, longitudinal study analyzing 1.7 million student selected lunch entrées in eight entrée categories 16 months before and 15 months after HHFKA implementation. Participants/ setting Three middle schools (MS) and three high schools (HS) in a Washington State urban school district. Main Outcome Measures Nutritional quality was assessed by analyzing Mean Adequacy Ratio (MAR), Energy Density (ED), and Energy per serving (ES). Quantity was determined by analyzing number of meals available and selected by students pre-and post-implementation. Statistical Analyses Performed Satterthwaite method was used to assumed unequal variances and Wilcoxon two-sample test with t approximation and two-sided alternative for small sample size and non-normal distributions. Results Post-implementation, significant improvement for nutritional quality was seen in MS (n=5) and HS (n=2). Every category with a significant increase in MAR also had a significant decrease in ES. Significance was seen for Salads (p = .0328 and p= .0172), Burritos (p= .0008 and p= .0015) and Pizza (p= .0156 and p= .0038) in MS, and Hot Sandwiches (p = .0023 and p <.0001) and Burritos (p = .0075 and p= .0068) in HS. For ED, MS also had significant decreases for Casseroles (p = .042) and Salads (p = .0265), with no significant changes in HS. The variety of entrées decreased by 44% and significant changes (p<.0001) in selection were seen for all categories except MS Casseroles. Conclusion HHFKA policy resulted in improvements in the nutritional quality of lunch entrees.